CMSA Today - Issue 1, 2014 - (Page 32)

Prescription Painkillers Opioid Abuse Crisis The plague of workers' compensation By Janet S. Coulter, RN, MSN, MS, CCM, and Kathleen Fraser RN-BC, MSN, MHA, CCM, CRRN D eaths from prescription opioid painkillers have reached epidemic levels in the past decade. Opioid analgesics are now responsible for more deaths than the number of deaths from suicide, motor vehicle crashes, cocaine, and heroin overdoses combined. Improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse, or overdose from these powerful drugs, while making sure patients have access to safe, effective treatment. In 2011, the escalating use of therapeutic opioids showed that hydrocodone topped all prescriptions in the country with a total of 136.7 million prescriptions. Additionally, all narcotic analgesics exceeded 238 million prescriptions, according to an abstract by Lau Manchikanti of the Pain Management Center of Paducah in Paducah, Ky. This trend has been caused by a host of factors, including a philosophical shift in physician attitudes toward the treatment of pain. The American College on Occupational and Environmental Medicine indicates that opioids are appropriate in the treatment of acute musculoskeletal pain only on a short-term basis, and for chronic pain only when other methods and medications have failed. Taking a different tack, The Joint Commission on the Accreditation of Healthcare Organizations embraces a patient-centered approach to pain management: their core principles state that "patients have a right to pain assessment and management, and a patient's self-report is the most reliable indicator of pain." While this attitudinal shift may be positive for chronic pain sufferers, regulatory systems must be designed to effectively monitor these powerful prescriptions. Opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved in about three of every four pharmaceutical overdose deaths, confirming the predominant role opioid analgesics play in drug overdose deaths. According to Tom Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC), "Appropriate screening, identification, and clinical management by health care providers are essential parts of both behavioral health and chronic pain management." The most surprising element is that the payer community has been consistently paying for these drugs but has shown little concern for curbing the abuse. While the responsibility doesn't lie with payers alone, it is now critical that workers' compensation stakeholders come together to stop these inappropriate prescribing patterns. There needs to be better mechanisms to hold prescribers accountable, enable the use of Opioids are highly addictive and can cause a change of motivation within the injured employee. If the employee becomes addicted to the opioid, their focus of recovery from the injury is replaced with one of obtaining more of the opioid. 32 CMSA TODAY Issue 1 * 2014 * DIGITAL drug monitoring and testing, and monitor pain management clinics. In 2012, over half a million emergency department visits were due to people misusing or abusing prescription painkillers. Nonmedical use of prescription painkillers costs health insurers up to $72.5 billion annually in direct health care costs. Furthermore, certain groups are more likely to abuse or overdose on prescription painkillers. For example, many more men than women die of overdoses from prescription painkillers. Additionally, middle-aged adults have the highest rates of overdose, and people in rural counties are nearly twice as likely to overdose as people in big cities. Another main issue is that the supply of prescription painkillers is larger than ever. The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors' offices was four times larger in 2010 than in 1999. Many states report problems with "pill mills" where doctors prescribe large quantities of painkillers to people who don't need them medically. Some people go to these "pill mills" so they can obtain drugs and resell them on the street. Other people obtain prescriptions from multiple prescribers by a process referred to as "doctor shopping." Pinning down where the problem of opioid abuse lies is a task that is arguably as tough as correcting the problem itself. Among the solutions that a number of states have adopted or are considering to tackle this multifaceted problem are: improving utilization of statewide databases that track opioid prescriptions; ferreting out and punishing overprescribing doctors; dealing with the growing number of pain management clinics; and

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2014

President’s Letter
CMSA Corporate Partners
Association News
The Opportunity to Lead Change
An Integrated Approach
Health Care Reform in the Military
Innovation as Necessity
Opioid Abuse Crisis
Index of Advertisers

CMSA Today - Issue 1, 2014

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